Peanut and Food Allergies

I remember growing up as a child in the 1980s when there was less worry about food and peanut allergies. Peanut butter and jelly sandwiches could be found everywhere, including schools. Now, as a parent of 2 young children, I have to be mindful of my children bringing any peanut-containing snacks to school. Schools have progressed from peanut-free tables to peanut-free schools. Because the prevalence of peanut allergies has doubled over the past 10 years in Western countries like the U.S. and the U.K, peanut-free zones are critical not for convenience but to prevent food allergy related deaths. Peanut allergies account for a significant number of food allergy related deaths. It is important to understand the new discoveries of how peanut and food allergies are being developed.

Previous Recommendations on Peanut Allergy-

Food allergy affects up to 8% of children up to 3 years old, and peanut allergy, specifically, affects up to 3% of children in Western countries like the United States and the United Kingdom. How did peanut allergy rates double over the past decade? It was initially thought that a strategy to prevent peanut allergy was to avoid exposure to it. Back in 2000, clinical practice guidelines in the U.S. and the American Academy of Pediatrics recommended to parents the avoidance of peanut and allergenic products in high risk infants by excluding allergenic foods from infants’ diet as well as excluding these foods from a mother’s diet during pregnancy and lactation. Clinical practice guidelines in the U.K. recommended the same at that time. These guidelines recommended peanut avoidance before the age of 3 years old. As a result, both the U.S. and the U.K. saw food allergy rates, such as peanut allergy rates, shoot up over the past 10 to 15 years. Once you are peanut allergic, it is almost impossible to outgrow this food allergy. Having a peanut allergy can also cause psychosocial and economic stress to the child and the whole family check over here. As peanut allergy rates increased, the clinical practice guidelines of early peanut avoidance in the U.S. were lifted in 2008, but there are still so many uncertainties on what to do and recommend. Until now!

Recent Research of Peanut Allergies-

“Learning Early About Peanut” (LEAP), part of the Immune Tolerance Network, recently published 2 landmark trials in order to strive to answer the question of whether early exposure to peanuts can reduce the risk of developing a peanut allergy. In February 2015, LEAP presented that early consumption and exposure to peanut products reduces a child’s chance of developing a peanut allergy. In this 2015 study, over 600 high-risk children (4 to 11 months old) were randomized to consume or avoid peanut until 5 years old. High-risk children included ones with a personal or family history of allergies and/or atopy (including eczema). Children were exposed to peanut by consuming a peanut-containing product at least 3 times a week. The results showed that in children who avoided peanut products, 17% developed a peanut allergy by 5 years old, while only 3% of children who were exposed to peanut products developed a peanut allergy. This study was the first impactful study to show that early peanut exposure reduces a high-risk child’s chance of developing a peanut allergy.

On March 4, 2016, the follow-up LEAP-on study published in the New England Journal of Medicine (http://www.ncbi.nlm.nih.gov/pubmed/26942922) showed that the participants in the LEAP trial who had not developed peanut allergy due to early exposure remained protected against a peanut allergy when there was cessation of peanut consumption for 1 year. What this LEAP-on study showed was that only 4.8% of children who regularly consumed peanut products during LEAP trial were allergic to peanut following a year of peanut avoidance. On the contrary, there was 18.6% prevalence of peanut allergy in children who had avoided peanut products throughout both LEAP and LEAP-on trials. In other words, exposure to peanut products early on (before 5 years old) helped to prevent peanut allergy and preventing peanut allergy did not need continuous exposure to peanuts to allow this sustained prevention.

These 2 significant results by LEAP are huge! What occurred from these results are the Updated Guidelines and Consensus Regarding Peanut Allergies-

In August 2015, the American Academy of Pediatrics joined on with 11 other organizations to highlight the evidence to support early peanut introduction to infants.

“Consensus communication on early peanut introduction and the prevention of peanut allergy in high-risk infants: The purpose of this brief communication is to highlight emerging evidence to existing guidelines regarding potential benefits of supporting early, rather than delayed, peanut introduction during the period of complementary food introduction in infants. This document should be considered as interim guidance based on consensus among the following organizations: American Academy of Allergy, Asthma & Immunology, American Academy of Pediatrics, American College of Allergy, Asthma & Immunology, Australasian Society of Clinical Immunology and Allergy, Canadian Society of Allergy and Clinical Immunology, European Academy of Allergy and Clinical Immunology, Israel Association of Allergy and Clinical Immunology, Japanese Society for Allergology, Society for Pediatric Dermatology, and World Allergy Organization. More formal guidelines regarding early-life, complementary feeding practices and the risk of allergy development will follow in the next year from the National Institute of Allergy and Infectious Diseases-sponsored Working Group and the European Academy of Allergy and Clinical Immunology. (J Allergy Clin Immunol 2015;136:258-61.)”

What about studies for other food allergies?

Looking beyond peanuts alone, the Enquiring about Tolerance (EAT) trial out of the United Kingdom (UK), published in March 2016 in the New England and Journal of Medicine, investigated the question of whether early exposure to certain allergenic foods would reduce the risk of developing an allergy to those foods that were studied. In general, it is recommended (from the World Health Organization) that children less than 6 months old be exclusively fed breast-milk. This EAT trial examined whether early exposure to allergenic foods as early as 3 months old could lower the risk. In the UK, results from an infant feeding survey showed that 45% of mothers of infants 8 to 10 months old reported avoiding giving their child certain foods (nuts, dairy, fish) since the fear was exposure to these foods could increase the development of a food allergy. This trend pushed this trial to answer the question of early exposure. In this EAT study, the foods that were studied were peanuts, egg, milk, sesame, fish and wheat. Subjects were put either into the early exposure (beginning exposure at 3 months old) or standard exposure (beginning exposure at 6 months old). The study showed that early exposure to peanut and egg lowered the risk of developing a food allergy to these foods but not milk, sesame, fish, and wheat. The study confirmed early exposure to peanuts and eggs is helpful to lower those food allergy risks, but not with milk, sesame, fish and wheat.

What does all of this mean for parents?

If your child has not shown any signs of food allergies and does not have a high-risk background of personal or family history of allergies or eczema, then you could consider introducing peanut-containing products into your child’s diet as soon as they are eating solid food. DO NOT give your child peanuts as they pose choking hazards for children younger than 4 years old.

If your child has shown signs of food allergies and has a high-risk background of allergies or eczema, you should consult with an allergist or pediatrician before exposing your child to peanut-containing products.

If your child has shown any reaction to peanuts or a peanut-containing product, DO NOT give your child any peanut-containing product. Discuss these results with your allergist or pediatrician.

The Baby Pibu team hopes this helps parents sort through the latest studies, updates and guidelines regarding peanut and other food exposure. To learn more, click the links to the leap studies and eat study.